At free clinics survival trumps politics

Dr. David Trigg, medical director at the Good Samaritan Clinic of Jackson County, doesn’t know if he should do more or less to treat the uninsured. While he and the other volunteer doctors at free clinics are their patients’ only option for health care, he sometimes feels they’re the ones propping up a broken system.

“You feel like the boy with his finger in the dyke,” Trigg said. “Not only is it not the solution to the problem, but it paralyzes you. But don’t tell our patients that. They don’t have any alternative.”

Trigg has seen the failure of health care for the poor from a number of angles. As an emergency room doctor who currently works part-time intermittent shifts in Cherokee, he has seen the way uninsured chronic care patients clog the country’s critical care facilities.

“The ER is the safety net for people who don’t have insurance, and it’s not sustainable,” Trigg said. “If emergency rooms keep getting busier, not only will the poor suffer because they’ll continue to get boarded, but the rich will begin to suffer because they’ll be so inundated they won’t get to the critical cases,” said Trigg.

As a volunteer primary care provider at a free clinic, he has seen how people without insurance work to get better, to work some more to pay their bills, without ever having any real hope of getting insured.

“The patients will break your heart. Let’s talk about a man who works three jobs and his employers deliberately won’t give him 40 hours per week so they don’t have to provide insurance,” said Trigg.

As a teaching doctor at Western Carolina University’s health science program, he has seen how the insurance reimbursement system discourages doctors from going into primary care, creating shortages.

“Part of reform has to be — not debt forgiveness — but scholarships for doctors who go into primary care,” said Trigg. “I think a lot of young people would go a year for a year. You have to pay primary care providers more and specialists less.”

For Trigg, the fact that North Carolina has 77 free clinics — the most in the nation — is neither an indictment nor a credit. It’s a reality.

“Anytime someone gets into the free clinic, they realize — consciously or subconsciously — that the system is broken. They’re not necessarily politically motivated though because they’re in survival mode,” said Trigg.

Trigg thinks part of the reason the debate over health care is so contentious is because the people who know the system is broken are too disillusioned to join the discussion.

In many ways, the health care debate is as simple as the separation between rich and poor, and the poor don’t often tell their own story as well as others tell it for them.

Becky Olson, Good Samaritan Clinic of Jackson County’s executive director, said her impression of the clinic’s patients is they don’t believe their government listens to them, so they don’t bother speaking to it.

“What I do feel and see here is a real sense of disenfranchisement,” Olson said. “I’m not sure how many of our patients vote because there is a feeling it wouldn’t make a difference. The real voices in this discussion on both sides are coming from people who don’t have to worry in the same way about where their health care comes from.”

Olson, a registered nurse who has spent the last 30 years working in a variety of settings from labor and delivery to long-term care, began volunteering at Good Samaritan when the free clinic opened in 2001 and became executive director in 2006. She is increasingly frustrated that health care has become a politicized discussion about costs, when the human cost of failing to provide affordable health care is decimating people’s lives and increasing the gap between rich and poor.

“The bottom line right now is it’s not working for a significant part of the population,” Olson said. “I haven’t heard anyone who can say with certainty how much it might cost or how much it might save to change the system.”

For Olson the issue is simple. The patients she sees everyday shouldn’t have to wait in lines at free clinics to get treated for everyday health issues like asthma, diabetes, hypertension, and back pain.

“This is not the way that health care ought to be gotten. If our clients had a better way into the system, we would with great pleasure close the doors,” Olson said.

For a long time, health care providers stayed out of the debate over health care policy. In general, doctors and nurses are practical people focused on their work, but Olson has grown increasingly exasperated by the argument that the government shouldn’t pay to provide care to the poor.

“That kind of argument ... if you don’t think the government should be running programs for poor folks, then maybe you shouldn’t take Medicare,” Olson said.